My shoulder and elbow pain book was just mentioned in a nice article in the Denver Post by Linda Buch. I love Linda’s holistic approach to her answers. This article answered a question by a gentleman recovering from shoulder surgery (biceps tendon and rotator cuff repaired; bone spur and arthritis removed) and wanted to know what strengthening exercises he should perform now that his rehab is over.

The assumption here is that rehab addressed all the problems in the shoulder system. Especially when I hear about multiple types of damage to a shoulder joint such as the one described here (involving muscles, tendon, bone, ligaments, and the now the joint capsule) my first thought is there is more going on here than just a shoulder joint not working well. My second thought is this person either has a very high tolerance for pain or little awareness of their body mechanics (or both) to have this much damage. So we need to step back for a second and look at his bigger picture.

The more I work with difficult chronic pain patients, the more I appreciate the interconnections of the human body. The shoulder system’s foundation is the scapula. Poor function of the scapula leads to stress of the shoulder joint. But what is affecting the scapula? Turns out everything. The scapula’s orientation is strongly influenced by the rib cage which can become depressed on one side. The tissues creating this depression attach to the pelvis, altering its orientation. The pelvic orientation can be influenced by the foot. There are many other mechanical influences I could mention too.

When we think about these connections, we typically think in terms of the bones that connect these areas. If we know a little anatomy, we might also be able to connect muscles across this span. Recently I’ve learned about fascial connections of these areas. But what is the underlying connection even between all these tissue systems? I think it is our nervous system including the peripheral nerves that control our limbs and the central nervous system (brain and spinal cord). In the future I’ll be writing more about the nervous system’s control of these tissue systems (as I learn more myself!).

The nervous system is where I am beginning to look for answers and where I believe my treatment is going. Changes here can happen quickly which then alter these tissues quickly (and therefore pain).

I’d love to hear your thoughts on the subject!